Day Case Treatment Research Articles

The cost evaluation of day-case compared to inpatient cochlear implantation in adults: subanalysis of a randomized controlled trial

ObjectiveTo investigate the assumption that day-case cochlear implantation is associated with lower costs, compared to inpatient cochlear implantation, while maintaining equal quality of life (QoL) and hearing outcomes, for the Dutch healthcare setting.Study designA single-center, non-blinded, randomized controlled trial in a tertiary referral center.MethodsThirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group (i.e., one night admission). We performed an intention-to-treat evaluation of the difference of the total health care-related costs, hospital and out of hospital costs, between day-case and inpatient cochlear implantation, from a hospital and patient perspective over the course of one year. Audiometric outcomes, assessed using CVC scores, and QoL, assessed using the EQ-5D and HUI3 questionnaires, were taken into account.ResultsThere were two drop-outs. The total health care-related costs were €41,828 in the inpatient group (n = 14) and €42,710 in the day-case group (n = 14). The mean postoperative hospital stay was 1.2 days (mean costs of €1,069) in the inpatient group and 0.7 days (mean costs of €701) for the day-case group. There were no statistically significant differences in postoperative hospital and out of hospital costs. The QoL at 2 months and 1 year postoperative, measured by the EQ-5D index value and HUI3 showed no statistically significant difference. The EQ-5D VAS score measured at 1 year postoperatively was statistically significantly higher in the inpatient group (84/100) than in the day-case group (65/100). There were no differences in postoperative complications, objective hearing outcomes, and number of postoperative hospital and out of hospital visits.ConclusionA day-case approach to cochlear implant surgery does not result in a statistically significant reduction of health care-related costs compared to an inpatient approach and does not affect the surgical outcome (complications and objective hearing measurements), QoL, and postoperative course (number of postoperative hospital and out of hospital visits).Level of evidence1.

Unicondylar knee arthroplasty-trigger for outpatient arthroplasty

The combination of areduction in surgical trauma in unicondylar knee arthroplasty compared to total knee arthroplasty and the introduction of astandardised enhanced recovery concept leads to apre-, peri- and postoperative improvement in the patient's condition, which results in areduction of the length of stay in hospital. In healthy, motivated patients, day-case or outpatient surgical treatment is possible under these circumstances.

Quality of life, hearing results, patient satisfaction and postoperative complications of day-case versus inpatient unilateral cochlear implantation in adults: a randomized controlled, equivalence trial

ObjectiveTo investigate the hypothesis that day-case cochlear implantation is associated with equal quality of life, hearing benefits and complications rates, compared to inpatient cochlear implantation.Study designA single-center, non-blinded, randomized controlled, equivalence trial in a tertiary referral center.MethodsThirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group. The effect on general quality of life, patient satisfaction, (subjective) hearing improvement, postoperative complications and causes of crossover and/or readmission were assessed using questionnaires, auditory evaluations and patients’ charts over a follow-up period of 1 year.ResultsOverall quality of life measured by the HUI3 was equal between the day-case (n = 14) and inpatient group (n = 14). The overall patients’ satisfaction showed a slight favor towards an inpatient approach. There was no significant difference in the subjective and objective hearing improvement between both treatment groups. During the 1-year follow-up period no major complications occurred. Minor complications occurred intraoperatively in three day-case patients resulting in three out of nine admissions of day-case patients. Other causes of admission of day-case patients were nausea and vomiting (n = 1), drowsiness (n = 1), late scheduled surgery (n = 2), social reasons (n = 1), or due to an unclear reason (n = 1). No patients required readmission.ConclusionWe found equal outcomes of QoL, patient satisfaction, objective, and subjective hearing outcomes between day-case and inpatient unilateral cochlear implantation. Nine out of 14 day-case patients were admitted for at least one night postoperatively (crossover). No major complications occurred in both groups. A day-case approach seems feasible when using specific patient selection, surgical planning and the preoperative provision of patient information into account. Besides this, the familiarity with a day-case approach of both patient and the surgical team can increase the feasibility of day-case surgery.Level of evidence1.

Hearing Results, Quality of Life, Patient Satisfaction, and Postoperative Complications of Day-case Versus Inpatient Stapes Surgery for Otosclerosis in Adults: A Randomized Controlled Trial.

To investigate the effect of day-case stapes surgery on hearing results, quality of life, patient satisfaction, and complications rates, compared with inpatient stapes surgery. A single-center, nonblinded, randomized controlled trial in a tertiary referral center. One hundred twelve adult patients planned for primary or revision stapes surgery were randomly assigned to either the day-case or inpatient treatment group. The effect on hearing outcomes (primarily), hearing benefits, quality of life, patient satisfaction, postoperative complications, and causes of crossover or readmission (secondarily) were assessed using auditory evaluations, questionnaires, and patients' charts over a follow-up period of 1 year. Audiometric measurements and postoperative success rates were not different between the inpatient and day-case group. There were no statistically significant differences between both groups regarding the overall quality of life (QoL) (HUI3), disease-specific QoL (GHSI), change in postoperative health status (GBI), and postoperative complications rate. We found a high patient satisfaction toward the day-case approach. Six patients allocated to the inpatient group requested same-day discharge. Of the day-case patients, there was a crossover rate to inpatient care of 38% (20 patients), mainly due to postoperative nausea and vomiting (25%), vertigo (20%), or dizziness (40%). We found no significant differences in outcomes of audiometric measurements, QoL, patient satisfaction and postoperative complications following day-case, and inpatient stapes surgery. Therefore, stapes surgery in a day-case setting seems to be a feasible approach in terms of postoperative outcome, safety, and desirability when taking patient selection and surgical planning into account. Besides this, the familiarity with a day-case approach of both patient and the surgical team, will increase the acceptance and feasibility of day-case stapes surgery.

Success of day-case treatment of zygomatic and orbital fractures

Traditionally, surgical management of zygomaticomaxillary complex (ZMC) and orbital fractures occurs within two to three weeks of the injury, followed by an overnight admission to allow for extended eye observations. This is due to the risk of postoperative retrobulbar haemorrhage (RBH) or orbital compartment syndrome (OCS), a rapidly progressive and sight threatening emergency that requires immediate intervention. In September 2016 the oral and maxillofacial surgery (OMFS) department at Leeds Teaching Hospitals redesigned their trauma service with a full-time trauma consultant, a dedicated clinic, and a weekly morning elective trauma theatre list. This allowed for standardisation of the management of patients with OMFS injuries. Furthermore, a formal day-case ZMC and orbital fracture pathway was developed to allow patients to undergo surgical management of such fractures with a same-day discharge. This has since been identified as an area of excellence by the Getting It Right First Time (GIRFT) programme, and is in line with the addition of ZMC and orbital fractures to the procedural list written by the British Association of Day Case Surgery (BADS). Unbeknown to the unit, the volume of day-case procedures was the highest within the UK, demonstrating the importance of GIRFT in highlighting areas of good or unique practice. The aim of this study was to determine the impact of our day-case pathway and designated OMFS trauma service on compliance with recent recommendations by GIRFT and BADS. Secondly, it was to determine the safety of same-day discharge with regards to postoperative complications.

Sheffield experience of administering Lutathera as a day case treatment

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Same-day discharge in benign esophageal surgery: a prospective cohort study

Day-case esophageal surgery has been demonstrated to be safe in small prospective cohorts and only for laparoscopic fundoplication. The aims of this study are to assess the feasibility and safety of a large series of esophageal day-case surgeries, including laparoscopic Nissen fundoplication (LNF), Zenker diverticulectomy (ZD), and laparoscopic Heller myotomy (LHM) and to compare the outcomes among three procedures.This was a prospective, observational study of selected patients who underwent day-case LNF, ZD, and LHM between 2003 and 2013. Postoperative outcomes, the patients' satisfaction, and functional results were evaluated with dedicated scores and compared.Of the 427 patients who underwent surgery for those indications during the study period, 168 (39.3%) eligible patients underwent day-case procedures (134 LNF, 14 LHM, and 20 ZD). The overnight unplanned admission rate was 16.2% and was similar among the groups (P = 0.681). Ten patients were readmitted during the first postoperative week because of dysphagia (n = 6, all in the LNF group), flu-like syndrome (n = 1), and secondary perforation (n = 3, all in the LHM group). The unplanned seven-day readmission rate was significantly higher in the LHM group than in the ZD and LNF groups (P = 0.042). The 30-day rates of unplanned readmission and consultation were 8.9% (P = 0.300) and 4.8%, respectively. At follow-up, 87.5% of the patients were satisfied with day-case treatment, and the functional results were good for 81.4% of the patients.Day-case esophageal surgery is feasible for LNF and seems to be feasible for ZD. Safety criteria have not yet been met for LHM, requiring further adaptations.

Effect of day-case unilateral cochlear implantation in adults on general and disease-specific quality of life, postoperative complications and hearing results, tinnitus, vertigo and cost-effectiveness: protocol for a randomised controlled trial

IntroductionCochlear implantation is an increasingly common procedure in the treatment of severe to profound sensorineural hearing loss (SNHL) in children and adults. It is often performed as a day-case procedure....

Day-Case Treatment of Peripheral Arterial Disease: Results from a Multi-Center European Study.

The purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease. This was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals. Exclusion criteria were not related to the type of lesion and included unavailability of an adult able to take care of patient overnight; high bleeding risk and ASA score ≥4. Primary efficacy outcome was the rate of procedures performed on an outpatient basis requiring no further hospitalization and primary safety outcome was freedom from 30-day major complications' rate. The study included 652 patients (male 75%; mean age 68±10years; range: 27-93), 24.6% treated for CLI. In 53.3% of the cases a 6Fr sheath was used. Technical success was 97.1%. Haemostasis was obtained by manual compression in 52.4% of the accesses. The primary efficacy outcome occurred in 95.4% (622/652 patients) and primary safety outcome in 98.6% (643/652 patients). Major complications included five (0.7%) retroperitoneal hematomas requiring transfusion; one (0.1%) common femoral artery pseudoaneurysm successfully treated with US-guided thrombin injection, two cases of intra-procedural distal embolization treated with catheter-directed local thrombolysis and one on-table cardiac arrest necessitating >24h recovery. No major complication was noted after same-day discharge. Day-case endovascular procedures for the treatment of IC or CLI can be safely and efficiently performed in experienced IR departments of large tertiary hospitals.

Medium-term Outcomes after Whole-gland High-intensity Focused Ultrasound for the Treatment of Nonmetastatic Prostate Cancer from a Multicentre Registry Cohort

BackgroundHigh-intensity focused ultrasound (HIFU) is a minimally-invasive treatment for nonmetastatic prostate cancer. ObjectiveTo report medium-term outcomes in men receiving primary whole-gland HIFU from a national multi-centre registry cohort. Design, setting, and participantsFive-hundred and sixty-nine patients at eight hospitals were entered into an academic registry. InterventionWhole-gland HIFU (Sonablate 500) for primary nonmetastatic prostate cancer. Redo-HIFU was permitted as part of the intervention. Outcome measurements and statistical analysisOur primary failure-free survival outcome incorporated no transition to any of the following: (1) local salvage therapy (surgery or radiotherapy), (2) systemic therapy, (3) metastases, or (4) prostate cancer-specific mortality. Secondary outcomes included adverse events and genitourinary function. Results and limitationsMean age was 65 yr (47–87 yr). Median prostate-specific antigen was 7.0 ng/ml (interquartile range 4.4–10.2). National Comprehensive Cancer Network low-, intermediate-, and high-risk disease was 161 (28%), 321 (56%), and 81 (14%), respectively. One hundred and sixty three of 569 (29%) required a total of 185 redo-HIFU procedures. Median follow-up was 46 (interquartile range 23–61) mo. Failure-free survival at 5 yr after first HIFU was 70% (95% confidence interval [CI]: 64–74). This was 87% (95% CI: 78–93), 63% (95% CI: 56–70), and 58% (95% CI: 32–77) for National Comprehensive Cancer Network low-, intermediate-, and high-risk groups, respectively. Fifty eight of 754 (7.7%) had one urinary tract infection, 22/574 (2.9%) a recurrent urinary tract infection, 22/754 (3%) epididymo-orchitis, 227/754 (30%) endoscopic interventions, 1/754 (0.13%) recto-urethral fistula, and 1/754 (0.13%) osteitis pubis. Of 206 known to be pad-free pre-HIFU, 183/206 (88%) remained pad free, and of 236 with good baseline erectile function, 91/236 (39%) maintained good function. The main limitation is lack of long-term data. ConclusionsWhole-gland HIFU is a repeatable day-case treatment that confers low rates of urinary incontinence. Disease control at a median of just under 5 yr of follow-up demonstrates its potential as a treatment for nonmetastatic prostate cancer. Endoscopic interventions and erectile dysfunction rates are similar to other whole-gland treatments. Patient summaryIn this report we looked at the 5-yr outcomes following whole-gland high-intensity focused ultrasound treatment for prostate cancer and found that cancer control was acceptable with a low risk of urine leakage. However, risk of erectile dysfunction and further operations was similar to other whole-gland treatments like surgery and radiotherapy.

Day-case stapes surgery: Day-case versus inpatient stapes surgery for otosclerosis: a randomized controlled trial.

BackgroundOtosclerosis is characterized by bony deposits in the otic capsule, resulting in stapes fixation and progressive hearing loss. It can be treated effectively by surgically removing (part of) the stapes and replacing it with a prosthesis. Increasingly, stapes surgery is performed as a day-case procedure. The major drive towards day-case surgery has been out of economic considerations. However, it is also increasingly an explicit patient request and leads to shorter waiting times for surgery, a reduced risk of infection and most likely positively influences the patient’s quality of life as a result of rapid discharge and rehabilitation. Even though stapes surgery seems well suited to a day-case approach, given the low complication rates and early recovery, evidence is scarce and of low quality.Methods and designA single-center unblinded randomized controlled trial was designed to (primarily) investigate the effect of hearing outcomes of day-case stapes surgery compared to inpatient stapes surgery and (secondarily) investigate the effect of both methods on quality of life, tinnitus, vertigo and cost-effectiveness. One hundred and twelve adult otosclerosis patients who are eligible for stapes surgery will be randomly assigned to either the day-case or inpatient treatment group. The primary and secondary outcome measures will be assessed using pure-tone audiometry (at approximately 2 months and 1 year follow-up), questionnaires (at 3 months and 1 year follow-up) and costs diaries (weekly the first month after which once a month until 1 year follow-up).Discussion/conclusionThis trial allows for a comparison between day-case and inpatient stapes surgery to investigate the hypothesis that day-case stapes surgery is associated with a higher quality of life and higher cost-effectiveness, while maintaining equal hearing results, compared to inpatient stapes surgery.Trial registrationNetherlands Trial Register (www.trialregister.nl): NTR4133, registration date 21st August 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12901-016-0024-6) contains supplementary material, which is available to authorized users.

Long-term day-case treatment of peripheral neuromuscular disease with intravenous immunoglobulin: the practice of a regional day-case service in Preston, Lancashire

Neuromuscular disease is one of the most common indications for the use of intravenous immuno-globulin (IVIG). We describe practical aspects of IVIG administration and dosing in long-term treatment, as well as the setting up of a day-case service in a regional neurology unit to provide a streamlined patient experience. An audit of the safety of IVIG administration and patient satisfaction during implementation supported the fact that this is a relatively safe treatment. Standardised assessment methods have been used both to monitor treatment effect and to provide the necessary outcome measures for Department of Health (DOH) monitoring of IVIG use.

Local-anaesthetic day-case treatment of Stelling type 1 ulnar duplication in babies up to 4 months of age

Local-anaesthetic day-case treatment of Stelling type 1 ulnar duplication in babies up to 4 months of age

The safety of the same-day discharge for selected patients after laparoscopic fundoplication: a prospective cohort study

Background We conducted a prospective cohort study to assess the acceptability, feasibility and safety of day-case laparoscopic fundoplication for gastroesophageal reflux disease in an university-based tertiary care center. Methods The procedure was proposed as routine for patients with proven symptomatic uncomplicated gastroesophageal reflux disease fulfilling predetermined inclusion criteria from September 2003 to December 2005. Standard anesthetic, surgical, analgesic, and antiemetic protocols were used. Acceptability, admission, complication, and reoperation rates and patient satisfaction were evaluated. Postoperative pain and nausea were assessed using an 11-point numeric rating scale (NRS). The Gastrointestinal Quality of Life Index (GIQLI) was administered before and after surgery. Results Among 100 patients screened, 40 (40%) were included. Seven patients were admitted because of inadequate pain control (n = 3), nausea or vomiting (n = 3), or anxiety (n = 1); 33 were discharged as planned 6 to 8 hours after operation. Only 1 patient was readmitted and reoperated because of fundoplicature migration following uncontrolled vomiting. At follow-up, 92.5% of patients were satisfied with the day-case treatment. If offered a similar operation in the future, 82.5% of patients would have accepted day-case treatment. The Gastrointestinal Quality of Life Index was 90.7 (±21.2) preoperatively compared with 105.8 (±21.8) postoperatively ( P < .001). Conclusions Day-case laparoscopic fundoplication is feasible in selected patients. However, (1) strict control of postoperative nausea and pain is essential, and (2) preoperative standardized education program for ambulatory surgery might be useful in order to enhance patient acceptability and satisfaction rates.

Laparoscopic Floppy Nissen Fundoplication for Gastro-Oesophageal Reflux Disease is Feasible as a Day-Case Procedure

We launched a prospective study to assess the feasibility of day-case laparoscopic fundoplication for gastro-oesophageal reflux disease in March 2003. The specific aims were to assess safety, acceptability and patient satisfaction. The inclusion criteria were American Society of Anaesthesiologists grade I-II surgical risk, body mass index < 35, and adult company at home (less than 50 km travel) or at patient hotel (more than 50 km travel). Patients were informed about the surgical procedure, the expected postoperative course, and the possible postoperative problems and complications. Surgery was performed under general anaesthesia with proposal-infusion, fentanyl, rocuronium and sevoflurane with air + oxygen. All patients received parenteral propacetamol, NSAID, local anaesthetics and metoclopramide, as pre-emptive analgesia before awakening. A total 360 degree floppy Nissen fundoplication was performed in all patients. Twenty-eight patients were included. There was one conversion to open surgery. All the other patients were discharged as planned and there were no readmissions. No intra- or postoperative complications occurred. Postoperative pain, nausea, fatigue and dysphagia were moderate. At interview the morning following the operation three patients reported they would rather have stayed over night at the hospital. However, all patients were ready for a similar procedure as day-case surgery again, if offered. At follow-up 26/28 (< 92.9%) patients were satisfied with the day-case treatment, one patient had no preference. All patients would recommend this operation as day-case surgery for a family member or friend. Laparoscopic day-case surgery for gastro-oesophageal reflux disease appears to be safe and well tolerated by the patients.

Botulinum toxin‐type A in the treatment of drug‐resistant neurogenic detrusor overactivity secondary to traumatic spinal cord injury

To assess, in a prospective study, whether botulinum toxin-type A (BTX-A) injected into the detrusor muscle, can be used as a day-case treatment for drug-resistant neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI). BTX-A (Dysport, Ipsen, Luxembourg; 1000 units) was injected cystoscopically into the detrusor muscle of 37 patients with drug-resistant NDO and SCI, as a day-case procedure. The maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), NDO, continence, and anticholinergic requirement were used as outcome variables. The International Consultation on Incontinence questionnaire (ICIQ) was used to assess the patient's quality of life before and after the BTX-A injection. The mean follow-up was 7 months. The MCC increased from a mean of 259 to 522 mL, and the MDP decreased from a mean of 54 to 24 cmH2O. Incontinence and NDO were abolished in 82% and 76% patients, respectively. In all, 86% of the patients were able to stop or reduce anticholinergics, with a similar proportion of patients scoring favourably on the ICIQ. The mean duration of improvement was 9 months. Injection with BTX-A is an effective day-case treatment that bridges the gap between oral and invasive surgical treatment of drug-resistant NDO in patients with SCI.

Can the English NHS meet the 18-week waiting list target?

Waiting lists for hospital treatment are often viewed as a peculiarly British disease. While it is erroneous to think that other developed countries do not suffer waiting lists,1 there is little doubt that long waits for hospital treatment have dogged the National Health Service for many years and are a source of dissatisfaction among patients. Waiting lists for treatment have grown steadily since the inception of the NHS. Only since 1999 has there been a sustained decline in the numbers of people waiting. Waiting times for treatment, perhaps a better measure of system performance, have waxed and waned over the last decade as various initiatives by governments of all political hues have sought to tackle the problem of service access. Successive governments have tended to focus on reducing the maximum waiting times for outpatient appointments and inpatient treatments. The current Labour government has now raised the stakes further. It has pledged that by 2008 there will be a maximum wait of only 18 weeks from any referral of a patient by a general practitioner to treatment in hospital if required. Such a target represents a large step up in expected performance. Current targets are that by the end of this year, no patient will wait more than 3 months for an outpatient appointment and a further 3 months for any inpatient or day-case treatment. Meeting the new target will require a massive effort, and despite considerable success to date, could it be a target too far? And, moreover, is there now a case for a change in focus on waiting times to address broader issues such as equity of access?

Outpatient laparoscopic cholecystectomy.

The results of laparoscopic cholecystectomy performed as an outpatient procedure were evaluated in a prospective study. Initially, only well motivated and healthy patients were offered outpatient laparoscopic cholecystectomy. After 50 procedures, all patients referred to the hospital, except those with American Society of Anesthesiologists (ASA) grade IV and those living alone, were included. Some 200 procedures were studied. Twelve patients (6 per cent) were admitted, and 188 (94 per cent) were discharged 4-8 h after operation. Fifteen patients (8 per cent) who had early discharge were readmitted, nine with complications; in six no complications were documented. The frequency of minor complications was 2 per cent and of major complications 5 per cent. Some 173 patients who had successful outpatient laparoscopic cholecystectomy completed a questionnaire: 164 (95 per cent) characterized their experience as excellent, five (3 per cent) as good, two (1 per cent) as intermediate and two (1 per cent) as unacceptable. This high achievement of day-case treatment, even in patients with ASA grade III, is explained by a new anaesthetic regimen together with good surgical technique and close follow-up.

Waiting lists, waiting times and admissions: an empirical analysis at hospital and general practice level

We report an empirical analysis of the responses of the supply and demand for secondary care to waiting list size and waiting times. Whereas previous empirical analyses have used data aggregated to area level, our analysis focuses on the supply responses of a single hospital and the demand responses of the GP practices it serves, and distinguishes between first outpatient visits, inpatient admissions, day-case treatment and emergency admissions. The results are plausible and in line with the theoretical model. For example: the demand from practices for first outpatient visits is negatively affected by waiting times and distance to the hospital. Increases in waiting times and waiting lists lead to increases in supply; the supply of elective inpatient admissions is affected negatively by current emergency admissions and positively by lagged waiting list and waiting time. We use the empirical results to investigate the dynamic responses to one off policy measures to reduce waiting times and lists by increasing supply.

Paediatric otolaryngology services in the UK: a postal questionnaire survey of ENT consultants

Approximately half a million children in England and Wales receive in-patient or day-case surgical treatment annually. Otolaryngology is the surgical specialty that provides the greatest number of episodes of such care. As 30-50 per cent of our total volume of work is paediatric, we feel it is important to assess current attitudes to paediatric otolaryngological practice. In its year 2000 document Children's Surgery: a First Class Service, The Royal College of Surgeons (RCS) of England sets out recommendations on how children's surgical services should be delivered in the UK. A postal questionnaire was sent to all UK-based ENT consultant members of the British Association of Otorhinolaryngologists-Head and Neck Surgeons (BAO-HNS). The questionnaire was designed to assess the current practice of paediatric otolaryngology in the UK with an emphasis on the RCS recommendations. Wide variations were found, and they are discussed with reference to the recommendations.